April 9, 2009

Get Aggressive to Beat Smoking

Doctors who really want to help their patients kick the habit need to get aggressive.

That's the take home message from two studies on smoking cessation. The first involved 750 people who smoked at least 10 cigarettes a day. Researchers randomized the smokers to three groups: one received a nicotine patch or bupropion, a drug to ease withdrawal symptoms; a second received one of the stop smoking aides plus up to two phone calls from counselors trained to help people quit; the third received a stop smoking aide plus three phone calls.

People assigned to the most intensive treatment "“ a stop smoking aide plus three phone calls from a counselor "“ were the most likely to quit smoking over the two year study.

The second study was conducted among 127 smokers with cardiovascular disease, COPD, or other chronic conditions. They were randomized to either a nicotine patch for ten weeks or the patch plus a nicotine inhaler and bupropion for as long as needed.

Again, quit rates were significantly better for people who received the more aggressive treatment, 35 percent at six months versus 19 percent.

The author of the first study, Edward Ellerbeck, M.D., from the University of Kansas, was quoted as saying, "We found that smokers are willing to make repeated medically-assisted attempts at quitting smoking, resulting in progressively greater smoking abstinence." He believes this suggests the need to take a disease management approach to smoking cessation.  "Physicians should talk to their patients continually about quitting, and should facilitate access to a smoking cessation medication."

Investigators from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School conducted the second study. They note patients in their study were already suffering the ill effects of smoking and people with these conditions are likely to be highly addicted to nicotine.

"Our trial demonstrates that intensive treatment with a triple combination of medications could work well for them," study author Michael B. Steinberg, M.D., M.P.H., was quoted as saying.

SOURCE: Archives of Internal Medicine, published online April 6, 2009